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Canoeing the Orne

September 30, 2014

Pont D’Ouilly to Thury Harcourt

This is a fine stretch of touring river, although some of the weirs are tricky. Hire customers in plastic self-drainers enjoy falling out, but traditional open canoeists need to take care.

0 km – Pont D’Ouilly. Weir and canoe club upstream of bridge. Glissade right.

pont doilly, weir   pont doilly     pont douilly to moulin

Launch right below the bridge. Alternatively launch in river Noireau, by the station road bridge, and shoot the weir pictured above.

0.75 km – Weir. Le Moulin Neuf. The shootable gap left runs into the bank, covered in rubber sheeting by the hire companies, but a too early break out has a high risk of capsize.

2 km – St Christophe bridge. Disused factory right. The line of the weir is marked on the map, and on the river by small buoys, but the weir itself has been flooded by the barrage downstream.

3km – Le Moulin barrage.  Power station right. Not shootable. A log slide eases the portage left.

orne barrage le moulin

5 km – Broken weir. Minimal drop. Shootable. The footbridge shown on both the map and Google Earth a few hundred yards downstream, had disappeared in August 2014.

6 km – Le Moulin à papier right. Weir. Glissage left marked by buoys. The drop is about a metre and steep. Lots of hire canoe capsizes. We got swamped. The portage left is easy.  The picture below is at moderately high water levels.

moulin to Clecy    1024px-Le_Bo_moulinàpapier

7.5 km – Barrage Le Bo. Despite an alarming sign on the right bank this is now just a broken weir with minimal drop.

8.5 km – Weir. La Bataille. The large gap left carries all the water at normal levels. Minimal drop. No problems. Shallows below.

9 km – Pont La Sauvegarde

pont dans la sauvegarde

10.5 km – Weir. Two large gaps left. Minimal drop.  Shallows below. Access left between weir and viaduct.

Clecy railway viaduct.

clecy bridge

11 km – Clecy left. Tour companies, rock climbing, abseiling, coffee and ice cream, bars and restaurants.  Camping right.

Weir. Tour boats shoot between the white buoys, but it’s a steep drop. I didn’t fancy it in my Canadian. Portage left.

11.5 km – Clecy road bridge. Toll house left. Excellent access just above the bridge on the right.

clecy toll house       P1060084   P1060085

12.5 km – island.  Shallows.

13 km – Cantepie bridge.  Shallows and small rapids above

P1060087

14.5 km – Les Maison Rouges left. Broken weir.  Easy shoot left

15.5 km – D562 bridge

16 km – Island. Minor rapids. Pass left. Factory right. Until recently there was a large dam here. Click here for the story of its removal (in French).

18.5 km – Weir. Le Moulin du Pont left. Quite a big drop, but the slope on the angled glissade is shallow. Shootable for open canoes.  The mill left is now a private residence; no chance of a portage through that garden.

P1060088   pont de la musse

19 km – Pont de la Mousse

P1060089   map around pont de la Mousse

19.5 km – Railway bridge. Shallows below.

21 km – Barrage Les Rivieres. Decent drop but the high-sided concrete shoot in the middle is gently sloping. OK for open canoes.

caumont

22 km – Broken weir. Minimal drop. Easy shoot left or right.

23 km – Railway bridge

P1060091

24 km – Camping left. Thury Harcourt canoe club right.  Land left or right above the weir. We stopped here. The weir looked to be too steep to shoot safely in an open canoe.

P1060042    P1060097    P1060092

24.5 km – Thury Harcourt bridge

P1060041     to thury-harcourt

Jim Thornton. August 2014

Birth Trauma

September 28, 2014

Best try to forget it and enjoy the baby

Despite modern pain relief and liberal Caesareans, traumatic births still happen. Delivery sometimes has to be rushed, forceps don’t always go as planned, epidurals may fail, or the baby’s shoulders get stuck.  Even births which appear normal to the midwife, may be perceived as traumatic by the mother.

Such women should be treated sympathetically, but should we do anything more?  Should we talk about what happened, or offer extra counselling? Many people think so. But might talking do harm – perhaps by encouraging rumination and bad memories?

We shouldn’t just assume that talking/counselling does good. We should compare outcomes among women offered extra counselling and those who were not. The best such evidence comes from randomised trials and from systematic reviews of such trials. What does it say?

There does not seem to be a Cochrane review of the effect of counselling/debriefing after traumatic birth. But there have been other systematic reviews.  One (click here) found 8 trials, six showed no effect, one possible harm and one possible benefit.

Another more recent evidence-based review (click here) found “midwife-led debriefing after an operative birth was ineffective in reducing maternal morbidity and the possibility of contributing to emotional health problems could not be excluded”. Or to put it another way, it doesn’t do good and might do harm.

Outside pregnancy the many trials of additional psychological support/therapy after other types of trauma, have been collected into two Cochrane reviews

The first (click here) showed no benefit from brief psychological support (BPS). If anything there was a non-significant trend for more post traumatic stress disorder (PTSD) after the BPS.

The second (click here) showed no benefit from multiple sessions of early psychological interventions. The authors concluded that “multiple session interventions, like single session interventions, may have an adverse effect on some individuals”.

All the above refers to preventive counselling/debriefing soon after the event. Psychological treatment for the minority who are unlucky enough to develop long-standing distress is a quite separate matter.

But this research is the reason that in the short term, parents who have experienced traumatic birth should be encouraged to get on with their lives and avoid special counselling. For most of them putting the birth behind them and enjoying the baby is good therapy. Talking to a counsellor about what happened is as likely to do harm as good.

Jim Thornton

Fourth Former Loquitor

September 19, 2014

By Philip Larkin

Larkin writing from a woman’s point of view, like Wedding Wind (here).

Although ostensibly by “Brunette Coleman”, the pseudonym he used for his mildly pornographic girls school stories, this poem is serious and convincing. “Grass between clear-cut lips, that never yet/Thrilled to the rouge” just erotic enough for the pre-teen girl. The ending is pure Larkin.

He never published it.

Fourth Former Loquitor

A group of us have flattened the long grass
Where through the day we watched the wickets fall
Far from the pav. Wenda has left her hat,
And only I remain, now they are gone,
To notice how the evening sun can show
The unsuspected hollows in the field,
When it is all deserted.
wwwwwwwwwwwwwHere they lay,
Wenda and Brenda, Kathleen, and Elaine,
And Jill, shock-headed and the pockets of
Her blazer full of crumbs, while over all
The sunlight lay like amber wine, matured
By every minute. Here we sprawled, barelegged,
And talked of mistresses and poetry,
Shelley and Miss LeQuesne, and heard the tale
Once more of Gwyneth and the garden rake,
Grass between clear-cut lips, that never yet
Thrilled to the rouge: a schoolbag full of books,
(Todhunter’s Algebra – for end of term
Does not mean you can slack) and dusty feet
Bare-toed in sandals – thus we lay, and thus
The filmy clouds drew out like marble veins,
The sun burned on, the great, old whispering trees
Lengthened their shadows over half the pitch:
Deckchairs that the governors had filled
Grew empty, and the final score was hung,
To show for once the Old Girls had been licked.
Ah what remains but night-time and the bats,
This flattened grass, and all the scores to be
Put in the magazine?
wwwwwwwwwwwwwBe not afraid,
Brenda and Wenda, Kathleen and Elaine
And brown-legged Jill – three years lie at your back
And at your feet, three more: in just a week
The end of term will part us, to the pale
And stuccoed houses we loved so much.

Wenda. Brenda, Kathleen and Elaine
Have flattened down the long grass where they’ve lain,
And brown-legged Jill has left her hat,
For they’ve gone to laugh and talk with those
Who’ve played the Old Girls’ match out to its close.

Philip Larkin

James Booth, in his new biography (click here), suggests Fourth Former Loquitor owes something to this poem by Dorita Fairlie Bruce (click here), author of the Dimsie girls school stories in the 1920s.

To the Old Girls of Clarence House, Roehampton 

O Schoolmates of the long-ago!
Though scattered now, and far away
From that white-pillared portico,
And flower-fringed terrace, and the wide
Green playing-field, and all beside
That made our world – come back, I pray!

Forget, for just a little space,
The broadened lives of later years-
Come back again and take your place
At scribbled desk of easel-stool,
In those old days which were so full
Of such tremendous hopes and fears.

I wove you rhymes and stories then,
So here’s one more if you will deign
To turn your footsteps back again,
And tread the class-rooms and the stairs,
Join in the morning hymn at prayers,
Or tread the wood’s leaf-shaded lane.

And if from words of mine you catch
One breath of the old cedars’ scent-
Hear blithe young voices cheer the match,
Across the sunny field, or see
Forgotten faces flushed with glee-
I shall be well-content.

Dorita F. Bruce

Japanese Maple

September 16, 2014

By Clive James

Clive James, essayist, commentator and poet, is terminally ill with leukaemia, but he’s retained his faculties. This was in yesterday’s New Yorker.

Your death, near now, is of an easy sort.
So slow a fading out brings no real pain.
Breath growing short
Is just uncomfortable. You feel the drain
Of energy, but thought and sight remain:

Enhanced, in fact. When did you ever see
So much sweet beauty as when fine rain falls
On that small tree
And saturates your brick back garden walls,
So many Amber Rooms and mirror halls?

Ever more lavish as the dusk descends
This glistening illuminates the air.
It never ends.
Whenever the rain comes it will be there,
Beyond my time, but now I take my share.

My daughter’s choice, the maple tree is new.
Come autumn and its leaves will turn to flame.
What I must do
Is live to see that. That will end the game
For me, though life continues all the same:

Filling the double doors to bathe my eyes,
A final flood of colors will live on
As my mind dies,
Burned by my vision of a world that shone
So brightly at the last, and then was gone.

Clive James

Why is Miriam Stoppard pushing HRT?

September 10, 2014

Undeclared conflict?

MiriamStopard

The columnist and childcare expert hasn’t a bad word to say about post-menopausal hormone replacement therapy (HRT).

On her website (click here), advising about menopause management: “The single most effective tool available is HRT. [...] [It] is more than 90 percent effective. If you feel your doctor isn’t being very helpful or sympathetic, or won’t let you try hormone replacement therapy, seek an opinion from another doctor.”

Referring to osteoporosis she writes: “Consider HRT once you are menopausal. Taking oestrogen in combination with progestogen for 10-13 days a month seems to optimise bone health and prevent fractures”. She fails to mention any risks, or that HRT is only recommended for osteoporosis prevention in women at high risk who cannot tolerate alternatives.

In 2012 in an article entitled “Why HRT is safe to combat menopause despite past scare stories” she linked the increased risk of cardiovascular disease identified in the WHI trials with the MMR/autism scare, and claimed without reference: “it’s been shown that HRT cuts the risk of heart disease in younger women”. (Click here).

In 2011 (click here) in response to a question from a patient whose GP was reluctant to prescribe HRT because of a strong family history of breast cancer (grandmother, aunt and cousin), she wrote: “HRT is better than ­any other menopausal remedy by a long stretch”, suggested getting a second opinion, and ended: “I’m hopeful your gynaecologist will find ­a way to give you HRT”.

This is biased advice.  Since the Women’s Health Initiative trials confirmed that HRT increases the risk of breast cancer, heart disease and strokes, all governments have advised that it should limited to treating symptoms only, and used in the lowest dose, for the shortest time possible, and never for health promotion. The idea that it might reduce heart disease when started soon after the menopause is not born out by independent analysis of all the trial evidence, e.g. the latest Cochrane review here. It remains a fringe obsession of a few “experts” with ties to the HRT industry. Dr Stoppard is entitled to her views but she also has a conflict of interest.

According to Debrett’s People of Today (click here) she worked for Syntex Pharmaceuticals Ltd between 1968 and 1981. She was associate medical director 1968-71, deputy medical director 1971-74 & 76 , and medical director 1974-76, & 1977-81. In 1991 she became a director of the Syntex Corporation and remains so to this day. Syntex manufactures and sells HRT.

I wonder why she forgets to mention this on her website, or in any of her HRT articles.

Jim Thornton

KEEPS trial results

August 28, 2014

Early postmenopausal HRT does not prevent vascular deterioration

There is good evidence that post-menopausal hormone replacement therapy (HRT) increases heart attacks and strokes. However, most of the patients in the randomised trials that provided that evidence started HRT or placebo 10 years or so after the menopause, and some had pre-existing heart disease.  Perhaps HRT started earlier in healthy women is preventive.  This “timing hypothesis” is popular with HRT manufacturers.

The Kronos Early Estrogen Prevention Study (KEEPS) tested the timing hypothesis by studying healthy women within three years of the menopause. They were divided into three groups and treated for 48 months as follows:

1) oral conjugated equine estrogens (o-CEE), 0.45 mg/day, plus progesterone 200 mg for 12 days/month.

2) transdermal 17β-estradiol (t-E2), 50 mcg/day, plus progesterone 200 mg for 12 days/month.

3) placebo.

The primary endpoint was change in carotid artery intima-media thickness (CIMT), a measure of the vascular damage which precedes heart attacks and strokes. The trial was randomised, double blind, registered here before starting, and follow-up of the 727 participants was completed two years ago – I grumbled about the delay in publication here. The results have just been published in the Annals of Internal Medicine here, or Keeps trial report.

HRT doesn’t protect the arteries.  Here is the change in CIMT over time in the three groups. Larger change means more artery wall thickening, a sign of damage.  Arteries in all three groups deteriorated over time but, although the deterioration was slightly greater in the two HRT groups, the difference was not statistically significant.

?????????????????????????????????????

 

The trial was too small to say much about substantive health outcomes – one woman died of an unspecified pelvic maligancy in the o-CEE group, and there was one non-fatal heart attack in the t-E2 group. There were no deaths or heart attacks in controls, and no strokes in the whole trial.

It’s a nice paper. It shows the power of good trial design – double blind, registered, sample size achieved, primary endpoint pre-defined and analysis by intention to treat.

The authors, mostly supporters of the timing hypothesis, were disappointed, but the many women who will avoid taking HRT in the vain hope of preventing heart disease should not be.

The best advice remains – if you must take HRT, take it for symptoms only, in the lowest dose and for the shortest time possible.

Jim Thornton

Private bypass

August 12, 2014

A431 toll road

Bathtollroad    crack   roadworks_2994954c

In February 2014 a landslip on the A431 between Bristol and Bath opened cracks in the road and forced a 14 mile diversion. It was tricky to repair; the council estimated it would be closed till the end of the year, and that a temporary bypass would cost £1.6M and take 16 weeks to build.

So in August local businessman, Mike Watts, took matters into his own hands and built a diversion a few hundred yards up the hillside. It took three men ten days, and £150,000; plus a further £1,000 per day to operate. So long as the council don’t speed up, £2 per car should pay for it.

diversion   Mike_Watts_at_a431_toll_road._Kelston

It’s the first new toll road in Britain since the M6 bypass, and the first privately built one for at least a hundred years.

We need more. Let’s replace the “free” tarmac we currently overuse  with correctly priced alternatives. Imagine the pollution that could prevent.

Jim Thornton

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